Provider Demographics
NPI:1851976096
Name:POLONUS, ZACHARY M (DDS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:M
Last Name:POLONUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S BEVERLY DR STE 180
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4815
Mailing Address - Country:US
Mailing Address - Phone:310-277-3451
Mailing Address - Fax:
Practice Address - Street 1:1700 W CHARLESTON BLVD # MS 7424
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2335
Practice Address - Country:US
Practice Address - Phone:702-774-5175
Practice Address - Fax:702-774-2812
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108923122300000X
390200000X
NVLL-556-211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program